CONGRESS REGISTRATION

Items marked with an asterisk (*) must be filled in.

Delegate personal details

Title (Mr, Mrs, Dr, etc.) *

First name *

Surname *

Profession *

Gender *

Male

Female

ID / Passport number *

HPCSA number *

Postal address *

Postcode

Telephone number

Cell number *

E-mail address *

Dietary requirements *

Registration fees

Membership rates – normal rate – R3500

Non-membership rates – normal rate – R5500

International delegate (not invited speakers) rate: R9000

Student rate: R1500

Day rate: R2250 per day

* Early bird rates are valid until 31 July 2025.

Registration category *

Which day will you attend?

Friday 12 September

Saturday 13 September

Sunday 14 September

Registration fee

Accommodation

Delegates should book accommodation directly with the hotel, and use the following reference number:

Reference: 6129684

Contact Person: Samantha Spahr

Email Address: reservations1@indabahotel.co.za

This information will also be in the email response you receive once you submit this form.

FLIGHT ARRANGEMENTS

Would you like XL Millennium Travel to assist you with flight arrangements? *

Yes

Departure city

Preferred airport of departure

Date of departure

Preferred time of departure

Date of return

Preferred time of return

Airline loyalty card membership number

Seating preference

Please upload a clear scanned copy of your ID

A travel consultant from XL Millennium Travel will be in contact with your shortly regarding your flight arrangements. The cost for this will be quoted for and invoiced separately from the registration form costs.

COST SUMMARY

Additional costs for this registration

Additional costs details

VAT included in this registration

Costs for this registration

Please select a payment option for your registration *

Bank Transfer / EFT

Credit Card - 3.5% transaction fee

Transaction Levy

TOTAL COST

All prices are in South African Rands.

Billing information

Company/Institution to be billed *

Billing contact person *

Billing person contact number *

Billing contact person e-mail address *

Billing address *

If you require your organisation's VAT number on your invoice, please supply that VAT number:

Payment information

Once you have submitted your registration form, you will receive an invoice. Payment details are on the invoice. Your registration is only confirmed once full payment has been received.

Additional information

Emergency contact person name and telephone number *

Is there any additional information that you would like to provide?

Declaration for Conference Delegates

I, [Name] [Surname], hereby declare that the information provided in this registration form is accurate and complete to the best of my knowledge.

I acknowledge and agree to the following terms and conditions of participation in the Podiatry Association 13^th Biennial Conference scheduled to take place on 12-14 September 2025 at The Indaba Hotel.

Attendance & Participation
- I understand that my registration is only confirmed upon full payment of the applicable conference fees (if any).
- I agree to abide by the rules and regulations set forth by the conference organisers.
Liability & Indemnity
- I acknowledge that I am responsible for my own travel, accommodation, and personal expenses related to attending the conference.
- I release the organisers, sponsors, and affiliates from any liability related to personal injury, loss, or damage of personal belongings during the event.
Code of Conduct
- I agree to conduct myself professionally and respectfully towards all delegates, speakers, and organizers.
- Any disruptive behaviour may result in removal from the event without a refund.
Use of Personal Information
- I consent to the collection and use of my personal information by the conference organizers for communication, event planning, and future correspondence.
- I understand that photographs and videos may be taken during the event, and I grant permission for their use in promotional materials unless I explicitly opt out in writing.
Continuous Professional Development (CPD)
- I acknowledge that CPD service providers are responsible for submitting attendance records directly to the HPCSA, and the issuance of CPD certificates is no longer mandatory.
- I commit to actively participating in CPD activities during this conference and to ensuring that my participation is duly recorded for CPD compliance purposes.
Cancellation & Refund Policy
- I understand that any cancellation or refund requests must comply with the event’s refund policy as outlined by the organisers.

By accepting this declaration, I confirm that I have read, understood, and agree to the terms stated above. *

PASA membership checked

Student number checked

PASA credit if any

CC/POP/PO Received

Date

Payment Amount

Payment Details

Hidden Notes

Cancellation

* = Input is required